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25A-121 (4) � P �� 1 � �� f �,� 1 �� n `� � , �%� � � � � ,� �� .�_ v5�� r� cr' L ._. k,�� Massachusetts -Department of Public Safety Board of Building Regulations and Standards ("P'ii1'M4Cta3sn s€ai cr° is��r sllc ialr-8 License: CSSL-099565 , F ti NICHOLAS R BERN1Fy , 7 PHILIP CIRCLE N" Granby MA 0103 i ��,w X11..61 • ,; Expiration Corninissioner 05128/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 147961 Type: Private Corporation Expiration: 8/23/2017 Tr# 267291 NRB EXTERIORS INC NICHOLAS BERNIER -- -- 7 PHILIP CIRCLE GRANBY, MA 01033 Update Address and return card.Mark reason for change. 20M•05/11 SCA 1 0 Address D Renewal C Employment Lost Card —' ��e�anarn.drruea�f>�i a�C��are��c>Cu��e�fs _._ _ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only U'VP'Epiration.ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 147961 Type: Office of Consumer Affairs and Business Regulation M23/2017 Private Corporatic n 10 Park Plaza-Suite 5170 Boston,MA 02116 NRB EXTERIORS INC NICHOLAS BERNIER 7 PHILIL CIRCLE GRANBY,MA 01033 Undersecretary Not valid without signature ........... �uOyljeen*oduod Insured ��dhp�� M@^Reg#I0'20057X0 Phone: 413-563-6334; MA Lic# 147961 Fux# 4679740 NIA CSL#:99565 ��B0��S �� p� (0mner) www.orhex1eriarm.uomm ROOFING&SEAMLESS GUTTERS Cedairibed Wiodvvvs Siding neda Residential Conunonnj^l Proposal submitted to: phone# 31 St City,,state,zip code Proposal mu furnish and install the following O Re-roof Tear-off O Goo^,s x+shall acquire necessary permits for uowork ` Complete Roof Preparation [� Home's exterior mhc protected hy tarps and plywood Shrubs,landscaping,trees mbe protected.roofers hugogyused Entire existing roofing materials mbo removed wexisting decking,including flashing,etc. Site to be cleaned on a daily basis with roll magnet,debris to be removed at project completioti 1)v clumpsier Deteriorated existing decking tuhe replaced u/$50 per sheet ofplrwuod Complete CertainTeed Integrity Roof System p0 Install YViou:q;v��icn^�°o,o,hurh�,u|nu�hmtvmO3��o[all K. Install Winterguard ice&water barrier around penetrations,in valleys and al I critical areas Install (j#saturated asphalt felt paper to entire decking ywInstall Roofers Select Premium uodnduymeu/m entire decking G& Install DiumoudDock Synthetic uodcr|aymon/w entire decking �O Install 8^perimeter metal flvxhin-/o all edges of all mafo.)�Vwhue L bmnn Install SwiftSton starter nbiuo|em bottom and rake edges of all roots Install CmuaioTood shingles to manufacturers specifications, O bmai|s D *nui|s Install Shingle Vent U PVC ridge vent tn all peaks ip heated areas Install Shadow Ridge m all hips and ridges,over ridge vent where uppiicub/c b8 Install new lead counter flashing mchimney New Ou,biuo,installed wborcnec^sxvry Install new pipe flashing m waste vent stacks Warranty options Wo-guaraotee our|uhm/wockmunabiy for 20yeum O Dp8,adcCeuuinT^cd5'3/m3vmS/m`P|us.50'yumomnywmtedcpvcogc. indudiug-workmanship CertainTeed Landmark-color: T—/, El CertainTeed Landmark Pro-color ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are 1/3 DOwn Paymena S satisfactory and are hereby accepted.You are authorized to do work as speciried. Balance duL Payment will be 113 down at start of job.and balance due upon completion. Upon completion S JJ Sion Name) Date: Estimator: (Print Narne) Estimates are honored for thirty(30)days from above date ATTENTION HOMEOWNERS:Please cover all personal belongings iu the attic,garage wrsmcug,areas uu«tothe possibility of roofing debris or dust in through cracks of the wood.NRB Exteriors fnc.�ll not be resPonsibiefor debris v,dust iu the attic v,storage areas. A Finance Charge vr/uem,mmv(ANNUAL raxccwrxos RATE op/x*)°mli'added mo`c Unpaid p."`/"n"/u,"h,u,`,"uu" � agree m pay and/or guwanw,payment"r`/esecharges,-in the event oruvl-avxvr,"x^~"`./agree it)pay rcvm"a,/vmu,,n^x"feo"nu conri coQ,�.This aureernent does not constitute a release ot'liabilitv.By iny signature below,ackno-,k an ag!ucnwni,i ft:al,o%u 1, CERTIFICATE LIABILITY INSURANCE rMTE 11OMYYY) 3/6/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSiTiUTE A CONTRACT BE1711I1MEN THE 6S IN G INSURE10), AUTHORIZED REPRESEI`tTATNE OR PROS AND THE SATE HMMElt IMPORTANT X the cerfificals holder Is an ADDITIONAL.INSURED,On poI1Wi w4 mush beemlonacL W 7{0101 IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorseme s. PRODUCER NTACT Tierney Team Tierney Group PHONE . (813)562-7007 FAX (898)291-2228 16 North Elm Street s� P O Sox 750 INSUREM AFF0111101110 COVERRISE NAIC# Westfield MA 01096 INSURERA:Penn America INSURED iNsuRERe:Safety Insurance Company 9454 N R B Exteriors Inc INSURER c:WCRIB Travelers 7 Philip Circle amp"D: IE G Ili 0103 COVERAGES CERTIFICATE NUMBER.,CL14102200185 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rA TYPE OF MURANCE POLICY l f POLICY EYP 1ANE8 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY $ 100,000 CLAIMS MADE r_X1 OCCUR PAV0016336 0/15/2014 0/15/2015 MED EXP one n $ 5,000 X subject to $500.00 PERSONAL&ADV INJURY $ 1,000,000 Deductible GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS`COh1PBOP AGG S 2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMI B ANY AUTO BODILY INJURY(Per person) $ 50,000 AUTOSNMED X ASHEOWLED 222362 /15/2014 /15/2015 BODILY INJURY(Per aceident) $! 11000.000 X HIRED AUTOS X q�OgVMED newal of PROPERTY DAMAGE $ 250,000 rM 22362 /15/2015 /15/2016 ; UMBRELLA LIA8 OCCUR EACH OCCURRENCE i EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED R NTI $ C WORKERS COMPENSATION ZZUB-2203175-4-14 /13/2014 /13/2015 1 WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE NIA A FOLLOW FROM COMPANY EL EACH ACCIDENT $ 100,000 OFFICER/MEMSEREXCLUDED? -ZUB-2203175-4-15 /1312015 /13/2016 (MyarxIatM In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 DESCRI�P to �ERATiDNS blow FOI'�� FROM COMPANY E.L DISEASE-POLICY LIMIT $ 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,AdMonal Remarks Scheckde,if more$"as Is mgw!ed) Siding, Window Installation, Carpentty, Roofing and Snow Removal/Plowing CERTIFICATE HOLDER CANCEL.LATtON (413)532-9410 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hadley Village Condominiums ACCORDANCE WITH THE POLICY PROVISIONS. 12 Hadley Village Road .South Hadley, , MAL 01075 AUTHORIZED REPRESENTATIVE f r Uy/ ACORD 25(2010!05) C 1888-2010 A CORPORATION. All righ reserved. INS025(201oos).o1 The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts w Department oflndustrialAccidents - '� I Congress Street,Suite 100 Boston, MA 02114-2017 r ` www mass.gov/dia NA orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lesibly Name(Business/Organization/(ndividual): `J Address: City/State/Zip: L ,-1 r� Phone#: V5 Are you an employer?Check the appropriate box: Type of project(required): 1.df4 am a employer with rl�_ employees(full and/or part-time).* 7. ❑New construction 1❑1 am a sole proprietor or partnership and have no employees working for me in g. E] Remodeling any capacity.[No workers'comp.insurance required.) 9. ❑Demolition 3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.] 10 Q Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 1 LC]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.) Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Z Z 1�4 _e t9 3 1 7 S Expiration Date: J t Job Site Address: A I( �_C C«It r City/State/Zip: f�/a''1�1 Vio-vol Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify d he pains and penalties of perjury that the information provided above is true and correct. Signature: _ Date: 1 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: b S1 --rM--\ Dt.-< The debris will be transported by: The debris will be received by: co" r LC � ��►`s �cn� l Building permit number: Name of Permit Applicant �j Date Signature of Permit Applicant SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction pSu�pervisotr: Not A(`p�plic(abbllee ❑ Name of License Holder: Jy` ,, , `G, \� � /v 1r.•(� J `�19 ) l.. License Number Address /I Expiration Date Signature Telephone 9.Re istered Home Improvement Contractor: Not Applicable ❑ Companv Name Registration Number Address Expiration Date Telephone r6 i `(•3 S-1 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes........& No...... ❑ 11. - Home Owner Exemption The current XFrnption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow subk homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as su ervisor.C R 780 Sixth Edition Section 108.3.5.1. Definition of Hom wner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, one or two family dwelling,attached_of,detaehcdtfiictres accessory ch use and/or farm structures.A verson who structs more than a in a two-year period shall not be considered a homeowner. Such"homeowner"shall submi the B ng Official,on a form acceptable to the Building Offici 1.that he/she shall be res onsible for all such work e d under the buildin As acting Construction Su isor your pr a on the job site will be required from t� time,during and upon completion of the work fo hick this permit is Also be advised that reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuriea not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform,work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding[E3] Other[p] Brief Descrip' n of Proposed Work: -t .A_ Q�K i!S��`�y Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building:One Family )° Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction I. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize to act on my behalf,in,a lati ork authorized by this building permit application. Signature of Owner Date J"- \�L as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under t p ' and penalties of perjury. Print Na oe t(A Signature of Owner/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ku DONT KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO o DONT KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , Date Issued: C. Do any signs exist on the property? YES ® NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. �1,v1 Department use only City of Northampton Status of Permit: F JAN 4 206 Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans •'_ F_i.r,MA OXCso p 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office W S� �M ✓� Map Lot Unit W Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: AA � t4x �1 ,.� �,r �1-ton4 sip w Name(Print) j� Current Mailin Address: Telephone Signature 2.2 Authorized Aaen�tJ: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number 7 77 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 6 SHERMAN AVE BP-2016-0855 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25A- 121 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-0855 Project# JS-2016-001445 Est. Cost: $8800.00 Fee: 540.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NRB EXTERIORS INC 99565 Lot Size(sq. ft.): 10410.84 Owner: WILLARD TODD F& HEATHER R zoning: URB(100)/ Applicant: NRB EXTERIORS INC AT. 6 SHERMAN AVE Applicant Address: Phone: Insurance: 7 PHILIP CIRCLE (413) 563-6354 WC GRANBYMA01033 ISSUED ON.11512016 0:00:00 TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 1/5/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner